Provider Demographics
NPI:1558602862
Name:MUSHRALL, EMILY MAE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MAE
Last Name:MUSHRALL
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:MAE
Other - Last Name:STINCHFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4324
Practice Address - Country:US
Practice Address - Phone:207-491-4727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2579225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist